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LIFE REVIVAL LLC NPI 1023701067


NPI Information

NPI: 1023701067
Provider Name: LIFE REVIVAL LLC
Classification: Community/Behavioral Health - 251S00000X
Entity Type: Organization
Address:
6404 ROOSEVELT BLVD
PHILADELPHIA, PA
ZIP 19149
Phone: (267) 577-7747
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LIFE REVIVAL LLC is a community behavioral health in Philadelphia, PA. The provider is a private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. LIFE REVIVAL LLC NPI is 1023701067. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

6404 ROOSEVELT BLVD
PHILADELPHIA, PA
ZIP 19149-943
Phone: (267) 577-7747

The provider's authorized official is Daniel Lee .
The authorized official title is Director and has the following contact phone number (267) 259-4558.

The enumeration date for this NPI number is 5/26/2023 and was last updated on 5/26/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LP0808XNurse PractitionerPsychiatric/Mental HealthNo
2101YM0800XCounselorMental HealthNo
3103TC1900XPsychologistCounselingNo
4103TF0000XPsychologistFamilyNo
5103TP0814XPsychologistPsychoanalysisNo
6103TP2701XPsychologistGroup PsychotherapyNo
71041C0700XSocial WorkerClinicalNo
82084P0800XPsychiatry & NeurologyPsychiatryNo
92084P0804XPsychiatry & NeurologyChild & Adolescent PsychiatryNo
102084P0805XPsychiatry & NeurologyGeriatric PsychiatryNo
11251B00000XCase ManagementNo
12261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)No
13261QM0850XClinic/CenterAdult Mental HealthNo
14261QM0855XClinic/CenterAdolescent and Children Mental HealthNo
15251S00000XCommunity/Behavioral HealthYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.